Kabatas Serdar, Cansever Tufan, Yilmaz Cem, Kocyigit Ozgen Ilgaz, Coskun Evrim, Demircay Emre, Akar Aykan, Caner Hakan
Department of Neurosurgery, Baskent University, Ankara, Turkey.
Neurol India. 2010 Mar-Apr;58(2):248-52. doi: 10.4103/0028-3886.63807.
Epidural steroid injection (ESIs) is one of the treatment modalities for chronic low back pain (CLBP) with various degrees of success.
We analyzed the efficacy of fluoroscopically guided transforaminal epidural steroid injections (TFESIs) via a preganglionic approach in patients with foraminal stenosis due to lumbar spinal stenosis and lumbar discogenic pain with radiculopathy.
We analyzed the data of 40 patients (February 2008 and April 2009) with the diagnosis of CLBP and treated by fluoroscopically guided TFESIs via a preganglionic approach. Patients were followed-up at one month (short term), six months (midterm) and one year (long term) after injections. Follow-up data collection included the Visual Numeric Pain Scale (VNS) and North American Spine Society (NASS) patient satisfaction scores.
The mean age of the patients was 59.87 +/- 15.06 years (range 30 - 89 years, 25 women). Average follow-up period was 9.22 +/- 3.56 months. Statistically significant differences were observed between the pre-procedure and post-procedure VNSs (P < 0.01, Pearson Correlation Test). Improvements in VNS scores were correlated with improvements in the NASS scores. When the VNS scores were evaluated with respect to the age of patient, level numbers, gender, pre-procedure symptom duration and pre-procedure VNS, no significant differences were found (P < 0.05, linear regression test). At short term evaluation in post treatment (one month), 77.78 % of patients were found to have a successful outcome and 22.22 % were deemed failures. Overall patient satisfaction was 67.23 % in the midterm period. Additionally, 54.83 % of patients (N/n: 15/8) had a successful long-term outcome at a follow-up of one year.
Our data suggest that fluoroscopically guided TFESIs via a preganglionic approach, in patients with foraminal stenosis due to lumbar spinal stenosis and lumbar discogenic pain with radiculopathy, has effective outcome and patients responding to injection have significantly lower post-injection pain scores.
硬膜外类固醇注射（ESI）是治疗慢性下腰痛（CLBP）的方法之一，取得了不同程度的成功。
我们分析了经节前入路在透视引导下经椎间孔硬膜外类固醇注射（TFESI）对因腰椎管狭窄和腰椎间盘源性疼痛伴神经根病导致椎间孔狭窄患者的疗效。
我们分析了40例（2008年2月至2009年4月）诊断为CLBP并经透视引导下经节前入路TFESI治疗的患者的数据。在注射后1个月（短期）、6个月（中期）和1年（长期）对患者进行随访。随访数据收集包括视觉数字疼痛量表（VNS）和北美脊柱协会（NASS）患者满意度评分。
患者的平均年龄为59.87±15.06岁（范围30 - 89岁，25名女性）。平均随访期为9.22±3.56个月。术前和术后VNS之间观察到统计学上的显著差异（P < 0.01，Pearson相关检验）。VNS评分的改善与NASS评分的改善相关。当根据患者年龄、节段数、性别、术前症状持续时间和术前VNS评估VNS评分时，未发现显著差异（P < 0.05，线性回归检验）。在治疗后短期评估（1个月）时，发现77.78%的患者治疗成功，22.22%被视为失败。中期总体患者满意度为67.23%。此外，在1年的随访中，54.83%的患者（N/n：15/8）获得了长期成功结果。
我们的数据表明，经节前入路在透视引导下对因腰椎管狭窄和腰椎间盘源性疼痛伴神经根病导致椎间孔狭窄的患者进行TFESI，具有有效的治疗效果，对注射有反应的患者注射后疼痛评分显著降低。
